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   2018| September-October  | Volume 7 | Issue 5  
    Online since November 20, 2018

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India achieves WHO recommended doctor population ratio: A call for paradigm shift in public health discourse!
Raman Kumar, Ranabir Pal
September-October 2018, 7(5):841-844
DOI:10.4103/jfmpc.jfmpc_218_18  PMID:30598921
The Indian medical education system has been able to pull through a major turnaround and has been successfully able to double the numbers of MBBS graduate (modern medicine training) positions during recent decades. With more than 479 medical schools, India has reached the capacity of an annual intake of 67,218 MBBS students at medical colleges regulated by the Medical Council of India. Additionally, India produces medical graduates in the “traditional Indian system of medicine,” regulated through Central Council for Indian Medicine. Considering the number of registered medical practitioners of both modern medicine (MBBS) and traditional medicine (AYUSH), India has already achieved the World Health Organization recommended doctor to population ratio of 1:1,000 the “Golden Finishing Line” in the year 2018 by most conservative estimates. It is indeed a matter of jubilation and celebration! Now, the time has come to critically analyze the whole premise of doctor–population ratio and its value. Public health experts and policy makers now need to move forward from the fixation and excuse of scarcity of doctors. There is an urgent need to focus on augmenting the fiscal capacity as well as development of infrastructure both in public and private health sectors toward addressing pressing healthcare needs of the growing population. It is also an opportunity to call for change in the public health discourse in India in the background of aspirations of attaining sustainable development goals by 2030.
  11,363 484 -
HIV/AIDS epidemic in West Bengal: An overview
Suman Ganguly, Debjit Chakraborty, Dipendra Narayan Goswami
September-October 2018, 7(5):898-902
DOI:10.4103/jfmpc.jfmpc_192_17  PMID:30598930
Background: West Bengal is a low-prevalent state with high vulnerability for HIV. The state bears around 6% of HIV burden of India. With consistent effort on preventive, diagnostic, and curative services under National AIDS Control Program, HIV prevalence is gradually coming down. Our study objective is to determine the trend of HIV positivity among different groups/population attending Integrated Counseling and Testing Centres (ICTCs) over a period of 8 years and identify the group of population needing special attention. Methods: The study was conducted with available program data year-wise from 2008–2009 to 2014–2015 among different groups of population who attended ICTCs for HIV testing. Year-wise positivity was calculated and trend analysis was performed by linear regression method keeping year as regressor. Similar methodology was applied for different typologies among the high-risk groups (HRGs) and trend analysis was done using linear regression for the study period from 2012–2013 to 2014–2015. Results: HIV positivity among general male and non-pregnant individuals, HRG population, transgender (TG) population, and pregnant women showed a significant declining trend over the past 8 financial years, but the discordance rate remained almost the same. Regarding HIV positivity trend among different typologies of HRGs, trucker group showed a significant increase in HIV positivity over the past 3 years, whereas HIV positivity among other groups like female sex workers, men having sex with men, injecting drug users, and migrant labors did not undergo significant changes over the past 3 years. Conclusion: HIV-preventive services among truckers need to be emphasized. HIV screening services among the TG population should be further scaled up through more number of targeted interventions.
  2,764 78 -
Knowledge and practice about the foot care and the prevalence of the neuropathy among a sample of type 2 diabetic patients in Erbil, Iraq
Hemin Jawad Saber, Ali Shakir Daoud
September-October 2018, 7(5):967-974
DOI:10.4103/jfmpc.jfmpc_163_18  PMID:30598942
Context: Patients with diabetes need to receive medical care from collaborative, integrated teams with expertise in diabetes. They must also assume an active role in their care. One aspect of health education for diabetic patients is foot care, therefore identifying patients foot care knowledge and practice is central in diabetes management. Aims: To know level of foot care, to assess peripheral neuropathy and association between them. Settings and Design: Cross sectional study in Rizgary Teaching Hospital and Layla Qasim diabetic center in Erbil, Iraq. Subjects and Methods: A sample of 250 patients aged ≥ 18 years with type 2 diabetes were interviewed to complete a questionnaire about foot care. Then a Michigan Neuropathy Screening Instrument was used as screening tool to detect neuropathy. Statistical Analysis Used: Statistical Package for Social Sciences version 25 used with a statistical significance level of < 0.05. The results presented as rates, frequencies, percentages in tables and analyzed using Chi-square test. Results: The mean age of the sample was 53.75 ± 12.08 years. The mean knowledge and practice scores were 6.1 ± SD 2.6 and 5.8 ± SD 2.1, respectively. The majority of participants were of poor knowledge score and moderate practice score (38% and 40%, respectively). The percentage of neuropathy was 31.20%. The neuropathy was highest among those who had low knowledge score (P < 0.05). Conclusions: The mean knowledge and practice scores were moderate, knowledge had significant influence on practice. Peripheral neuropathy was significantly higher among those with low knowledge score.
  1,670 179 -
Parent's knowledge and practice in home management of fever in their children in Riyadh, Saudi Arabia
Mohammed M AlAteeq, Bader O AlBader, Sultan Y Al-Howti, Muayad Alsharyoufi, Jamal B Abdullah
September-October 2018, 7(5):1012-1018
DOI:10.4103/jfmpc.jfmpc_18_18  PMID:30598949
Background: Fever in children is a common presenting complaint during health visits. Parents frequently have concerns about fever and perceive it as a disease rather than a symptom of illness. Parent's practice of home managing of fever varies according to their background and experience. Objective: To explore parents' perception and practice in home management of fever in their preschool children in Riyadh, Saudi Arabia (SA). Materials and Methods: This is a cross-sectional study. Data were collected from 250 parents attending three main family medicine centers at King Abdul-Aziz Medical City, Riyadh, SA, using self-administered questionnaire. Results: Most of the parents (64%) defined fever correctly and 56% identified high fever. Almost all the parents (95%) believed fever is harmful, and febrile convulsion was the most concerned complication of fever (74%), followed by loss of consciousness, dehydration, brain damage, and hearing loss. Most of the parents (82%) touch their children to confirm fever, 68% use oral thermometer, and 63% use axillary thermometer. Most parents (84%) applied cold compression, 75% gave their children nonprescribed fever medication, 61% gave their children plenty of fluids, and 64% took their children to the doctor right away. Almost one-third of participants reported having difficulty either in choosing fever medicine or giving the proper dose and frequency. No difference in knowledge or practice was found in relation to difference in demographic characteristics of participants. Conclusion: Results of this study indicate poor knowledge and practice in regard to parent's management of febrile children, overuse of nonprescribed fever medication, and possible waste of health resources.
  1,321 160 -
A prospective study evaluating the impact of cartridge-based nucleic acid amplification test (CBNAAT) on the management of tuberculosis in a low-resource high-burden Indian rural setting
Jonathan Youngs, Sushil Patil, Yogesh Jain
September-October 2018, 7(5):982-992
DOI:10.4103/jfmpc.jfmpc_104_18  PMID:30598944
Background: The cartridge-based nucleic acid amplification test (CBNAAT) Xpert MTB/RIF is more sensitive than smear microscopy for the diagnosis of tuberculosis (TB). It is also more expensive, costing 1450 INR as compared to 10 INR per smear. Objectives: We conducted a prospective study to evaluate the impact of CBNAAT results on patient management in our low-resource, high-burden Indian rural setting. Materials and Method: Between February and July 2017, clinicians were asked to complete one questionnaire at the time of CBNAAT request and another when reviewing the result. The first questionnaire, “Form 1,” concerned pretest treatment status and asked clinicians to rate their confidence in the diagnosis. “Form 2” concerned postresult treatment and investigation plan. Results: Over the study period, 206 CBNAATs were requested. Form 1 was not completed for 85 patients and 21 were excluded leaving 100 in the main analysis. MTB was detected (MTB-D) in 60 of 100 (60%) of samples tested. At the time of CBNAAT request, 56 of 100 (56%) of patients were already on treatment, this being empirical in 34 of 100 (34%). Despite this, 17 of 60 (28.3%) of MTB-D results occurred in patients not yet started on treatment. Postresult treatment status was available for 94 of 100 CBNAATs (55 MTB-D and 39 MTB-ND). Following an MTB-D result, all 17 patients not on treatment started and all 38 on so already continued. Following an MTB Not Detected (MTB-ND) result, 26 of 27 (96.3%) of patients not yet on treatment remained so, but only 2 of 12 (16.7%) already on treatment stopped. Even where the clinician's pretest confidence in TB was low, 9of 30 (30%) of CBNAAT results were MTB-D. Conclusion: In a low-resource high-burden setting, CBNAAT may have greatest impact where the clinician's pretest confidence in TB is low and empirical treatment has not been started. This is because MTB-D results will lead to appropriate initiation of treatment and MTB-ND results may enable clinicians to hold-off treatment.
  894 70 -
Pemphigus vulgaris – A report of three cases and review of literature
Ishita Banerjee, Biyas Bhowmik, Anirban Maji, Rupam Sinha
September-October 2018, 7(5):1109-1112
DOI:10.4103/jfmpc.jfmpc_133_18  PMID:30598970
Pemphigus vulgaris (PV) is an autoimmune, potentially life-threatening disease causing blisters and erosions of the skin and mucous membranes associated with intraepithelial acantholysis. The underlying mechanism responsible for causing intraepithelial lesions is the binding of immunoglobulin G autoantibodies to desmoglein 3, a transmembrane glycoprotein adhesion molecule present on desmosomes. Histological features comprise intraepithelial cleft and Tzanck cells. Corticosteroids remain the mainstay of the treatment plan. In this article, we have discussed about the diagnosis of three patients suffering from PV, the treatment rendered, and the outcome of the same.
  810 117 -
Elementary school teachers' knowledge of attention deficit/hyperactivity disorder
Esra'a Yahya Al-Moghamsi, Abdulaziz Aljohani
September-October 2018, 7(5):907-915
DOI:10.4103/jfmpc.jfmpc_183_18  PMID:30598932
Background: Teachers are often the first ones to suspect attention deficit/hyperactivity disorder (ADHD) in their students, because they are with them for most of the day and they know how normal students typically behave in classroom situations. The aim of this study is to assess the teachers' level of knowledge of ADHD and identify some factors affecting that knowledge. Methods: It is a cross-sectional study conducted among male and female elementary governmental schools in Madina city during the year 2017/1438. A pre-validated and translated self-administered questionnaire is used in data collection. It includes demographical questionnaire and the Knowledge of Attention Deficit Disorder Scale. Results: The study included 416 teachers. Their age ranged between 22 and 66 years. The average percentage of knowledge regarding ADHD general information, symptoms/diagnosis, and treatment were 41.6 ± 15.1, 41.7 ± 15, and 30.7 ± 16.6, respectively. The average percentage of overall knowledge score regarding ADHD was 38 ± 11.3. Only experience in teaching (P = 0.042) and previous experience with a child with ADHD (P < 0.001) were significantly associated with teachers' knowledge regarding ADHD general information. Special need teachers had the highest score of knowledge regarding ADHD symptoms (mean rank was 283.7), P = 0.013, and they had the highest score of knowledge regarding ADHD treatment (mean rank was 261.9), P = 0.032. Teachers who reported previous experience with a child with ADHD expressed higher level of overall knowledge regarding ADHD, P < 0.001. Conclusions: The knowledge regarding ADHD among elementary school teachers in Madina is suboptimal, particularly regarding treatment.
  767 79 -
Herbal medicines: Saudi population knowledge, attitude, and practice at a glance
Munira Mohammed Al Akeel, Wadha Marzuq Al Ghamdi, Samia Al Habib, Mohammed Koshm, Faisal Al Otaibi
September-October 2018, 7(5):865-875
DOI:10.4103/jfmpc.jfmpc_315_17  PMID:30598925
Herbal medicines are widely used in many countries in preventing and treating health disorders. In this study, a multiregional cross-sectional survey, a random sample of 809 adults from Saudi Arabia and territories were used to explore the participants' knowledge, attitude, and practice regarding the use of tradition medicines in Saudi society. Data were collected through direct simple observation, interviews, and structured questionnaires. Observations were made and interviews conducted in public places such as markets and popular schools. The questionnaire included data on sociodemographic such as age and gender and was drafted with optional questions and predefined answer. Data were collected from May 1st to the end of July 2014. Most of the respondents were female (85%). Approximately 70% of participants were found to be highly knowledgeable about the use of herbal medicine. The study found that 88.4% of the respondents stated to have used herbal medicines and 84.3% were interested in traditional recipes. Most of the participants used it for therapeutic reason (88.7%), with a successful effectiveness of 61.2%. In addition, the study found that 48.2% of the participants were taking information from friends and 76% stated that they do not trust the published information in commercial channels. Statistical analysis showed an association between the perception and the demographic data, with an increase in the use of herbal medicines. Because of the increased use of herbal medicine in Saudi Arabia facilitated by perceptions and attitudes of the population, it is important to ensure standardization, stability, and quality control of the use of medicine in Saudi Arabia.
  753 92 -
An assessment of health-related quality of life among patients with chronic obstructive pulmonary diseases attending a tertiary care hospital in Bhubaneswar City, India
Sandipana Pati, Subhashisa Swain, Sangram Kishor Patel, Abhimanyu Singh Chauhan, Nutan Panda, Pranab Mahapatra, Sanghamitra Pati
September-October 2018, 7(5):1047-1053
DOI:10.4103/jfmpc.jfmpc_37_18  PMID:30598955
Background: Chronic obstructive pulmonary disease (COPD) is a major public health challenge in India with significant economic burden and healthcare utilization and contributes to patients' daily life limitations. Health-related quality of life (HRQoL) reflects the health- and disease-related aspects of QoL. Limited studies have examined this dimension in healthcare settings. We explored the HRQoL among patients with COPD attending a tertiary care facility and the factors (enablers and constraints) influencing it. Materials and Methods: A parallel mixed-method study design was adopted to undertake the study. Data were collected from 110 patients with COPD attending the outpatient department of the tertiary care hospital at Bhubaneswar, Odisha, during June and July 2014. The translated and pretested version of St. George Respiratory Questionnaire (SGRQ) was used. In addition, in-depth interviews were held with 11 patients. Results: The overall HRQoL was significantly lower in females and patients from rural area. It declined with increasing age and was worst in patients age 70 years or above. Patients having two or more comorbid conditions had the poorest HRQoL. Reason for not using inhalers was mentioned to be perceived harm due to prolonged use. Family support and better financial condition were enablers while easy accessibility of healthcare facilities helped in early interventions. Conclusion: COPD has considerable negative impact on the QoL with advancing age and is worse among the geriatric age group population. Acute exacerbations impair HRQoL. The degree of severity of COPD could be determined by SGRQ which reflects the impairment of their HRQoL.
  575 71 -
The impact of calendula ointment on cesarean wound healing: A randomized controlled clinical trial
Fereshteh Jahdi, Akram Haghighi Khabbaz, Maryam Kashian, Mohsen Taghizadeh, Hamid Haghani
September-October 2018, 7(5):893-897
DOI:10.4103/jfmpc.jfmpc_121_17  PMID:30598929
Background: Cesarean is one of the most common surgical interventions. Wound complications are one of the most common morbidities following cesarean section. Calendula promotes wound healing and might be effective in shortening the duration of wound healing. Limited researches have been done regarding the healing of this plant as the effect of this ointment on cesarean wound healing has not been studied. Therefore, the purpose of this study was to examine the impact of calendula on cesarean wound healing in primiparous females. Methods: This clinical trial involves 72 qualified primiparous females with surgical childbirth admitted in the Akbar-Abadi Educational Hospital. They were randomly categorized into two groups of experimental (n = 1) and control (n = 2) groups. The females in experimental group used calendula ointment every 12 h and the control group used hospital routine for 10 days. Wound healing was assessed on the 3rd, 6th, 9th days postcesarean using the REEDA scale (REEDA stands for redness, edema, ecchymosis, discharge, and approximation), which had criteria including redness, edema, ecchymosis, discharge, and approximation. The data were collected by demographic questionnaire and redness, edema were used Chi-square test and independent T-test for data analysis. Results: Seventy-two females were included in the study. Thirty-six cases in the drug group and 36 cases in control group were studied. The age of patients in the two groups did not differ significantly (27/17 ± 4/72, 28/97 ± 4/99 years, respectively; P = 0/276). Moreover, there was no significant difference between studied groups regarding the education level of patients and their husbands, the mother's job and the economic situation. Conclusion: According to the results, using calendula ointment considerably increases the speed of cesarean wound healing so it can be used for quickening the cesarean healing.
  560 76 -
Knowledge, attitude and perception toward evidence-based medicine among medical students in Saudi Arabia: Analytic cross-sectional study
Thamer Z Aldugieman, Rawabi S Alanezi, Wasmiah M. G. Alshammari, Yasmeen W. Z. Al-Shamary, Mishaal M Alqahtani, Fayez S Alreshidi
September-October 2018, 7(5):1026-1031
DOI:10.4103/jfmpc.jfmpc_129_18  PMID:30598951
Objective: To study the knowledge, attitudes, and perceptions toward evidence-based medicine among medical students from different colleges across the Kingdom of Saudi Arabia. Materials and Methods: An adapted evidence-based medicine (EBM) questionnaire was administered to second year to sixth year level of medical students and interns from different medical colleges across the Kingdom from November 2016 to May 2017. The questionnaire contains items that would describe the demographic characteristics of the respondents: 24 multiple-choice questions and one open-ended question. Questions were randomly arranged to refrain from respondents' bias but are identified to determine the knowledge, attitudes, and perceptions of the respondents toward evidence-based medicine (EBP). Data were analyzed statistically using descriptive statistics. Results: This study surveyed 344 medical students from different universities in Saudi Arabia. The students' knowledge and attitude to EBM were low: 80.8% answered incorrectly on the components of EBM; 40.4% knew that the strongest evidence to EBP is systematic review, and 95% of the respondents were not aware of the Cochrane Library (CL). Nearly 70% did not attend EBP workshops, 18% read journals, and 85.8% use the Internet to support clinical decisions. Only 50% are interested of knowing and using CL, 69.5% would evaluate the veracity of evidence when it contradicts clinical judgment, 24.4% will follow the evidence, and 6.1% will discard the evidence favoring their clinical judgment. No journal subscription, having no time, and difficulty in comprehension were the greatest reported barriers with a relative weight of 29.1%, 25%, and 15.7%, respectively; 68.8% claimed that EBP is not applicable to their culture, and 87.1% believed that their patients are willing to participate in clinical decision-making but perceived a low participation in clinical trials. Conclusion: The findings described the current status of the level of awareness and use of EBM among the medical students. This calls for a well-structured incorporation of the pedagogy into the undergraduate curriculum as a major competency standard considering culture and values that are well-preserved in the Kingdom. The outcomes of its integration will impact not only the medical and allied-medical professions but also the public health in general.
  549 82 -
The effect of glucomannan on pregnancy constipation
Fatemeh Janani, Farahnaz Changaee
September-October 2018, 7(5):903-906
DOI:10.4103/jfmpc.jfmpc_168_18  PMID:30598931
Introduction: Constipation is a common complication among pregnant women; it refers to hard and infrequent bowel movements where the stools defected from body becomes hard and dry, as well. various medical interventions are nowadays implemented to treat constipation, Some of which are either banned or not willingly implemented by pregnant women; thus, doctors try to avoid such methods. Glucomannan, a combination of a few simple sugars, is an effective substance for treating constipation. According to the results of studies conducted in this area, glucomannan has been greatly welcomed and approved by pregnant women. Thus, the present study was conducted to investigate the effect of glucomannan on pregnancy constipation and to compare it with other common treatment methods. Materials and Methods: This study is a clinical trial in which 64 pregnant women with constipation were investigated in the two groups of intervention and control (32 participants in each group). All participants were in their third trimester of pregnancy. The intervention group was treated with glucomannan, while the control group was treated with magnesium hydroxide. After 1 month, the participants were investigated and the questionnaires were responded to. The collected data were analyzed using the SPSS software and Chi-square tests. Results: The post-treatment frequency of bowel repulses increased in both the groups. However, the increase was different in the two groups. About 75% of the participants in the glucomannan group reported having at least 6 times of bowel movements. Moreover, 25% of the participants in the glucomannan group reported having >6 times of bowel movements. Using a Chi-square test, it was found that there is a significant difference between pre- and post-treatment frequency of bowel movements per week (P = 0.002). Moreover, there was a significant difference between the post-intervention frequency of bowel movements in the two groups (P = 0.001). Discussion: In the present study, it was attempted to investigate the effect of glucomannan on pregnancy constipation. The findings indicated that glucomannan is likely to improve constipation symptoms in pregnancy and reduce pregnant women's complaints to a significant level through increasing the frequency of bowel movements and affecting the stool consistency. Conclusion: Along with other treatment methods, glucomannan is recommended as a healthy medicinal plant for treating pregnancy constipation.
  570 60 -
The association between olive oil consumption and primary prevention of cardiovascular diseases
Sameer Al-Ghamdi
September-October 2018, 7(5):859-864
DOI:10.4103/jfmpc.jfmpc_191_18  PMID:30598924
Introduction: American Heart Association and many other recommend Mediterranean diet for patients with cardiovascular risk. This systematic review and meta-analysis are conducted to review the effects of Mediterranean diet on the cardiovascular events as reported in randomized controlled trials (RCTs). Methods: A systematic research is conducted on MEDLINE via Ovid, Embase, PubMed, Google Scholar, Web of Science, and Informit. Databases of studies conducted between 2000 and 2017 were included in the analysis. All the collected studies were screened, and at the end, seven RCTs met the inclusion criteria. All the characteristics of trails such as study design, interventions, follow-up duration, and primary and secondary outcomes were recorded. RevMan was used to evaluate risk reduction in each trial individual using forest plot and fixed effects. Results: Four studies were included in the review, having a total of 25,195 participants. The effects of Mediterranean diet were found in cardiovascular events (627), coronary events (251), and all-cause death (887). The analysis revealed that there is a statistically significant relationship between Mediterranean diet and reduction in cardiovascular events at P = 0.02. However, other parameters did not show any statistically significant results that need further investigation. Conclusion: The individual RCT provides evidence of protective effects of the Mediterranean diet on cardiovascular events. However, the quality and quantity of data available in those trails are not reliable and limited. Therefore, the results of those trails must be cautiously interpreted.
  491 120 -
The effect of hydro-alcohol extract of Tribulus terrestris on sexual satisfaction in postmenopause women: A double-blind randomized placebo-controlled trial
Mitra Tadayon, Mina Shojaee, Poorandokht Afshari, Eskandar Moghimipour, Mohammad Hossein Haghighizadeh
September-October 2018, 7(5):888-892
DOI:10.4103/jfmpc.jfmpc_355_17  PMID:30598928
Introduction: Increasing life expectancy in women and having menstrual problems and hormone-associated complications have led people to use complementary and alternative medicine. In menopause, the reduction in estrogen and androgen physiologically leads to a decrease in blood flow in the volvuleous and vaginal zone, resulting in a reduction in sexual desire and arousal. Sexual satisfaction plays an important role in mental health. The aim of this study was to investigate the effect of Tribulus terrestris on sexual satisfaction in postmenopausal women. Methods: This double-blind clinical trial was conducted in 2017 with the aim of investigating the effect of hydro-alcohol extract of T. terrestris on sexual satisfaction of postmenopausal women on 60 women referred to health center number 1 in eastern Ahvaz. A total of 60 postmenopausal women were randomly assigned into two groups of 30 to receive a syrup containing T. terrestris extract at a concentration of 0.9 mg and placebo for 8 weeks. Sexual satisfaction was calculated based on Larsson questionnaire. Data were analyzed by SPSS software (version 22) and t-test was used for comparing two groups in quantitative variables and Chi-square test was used for qualitative variables. P value less than 0.05 was considered significant. Findings: After intervention, the mean of sexual satisfaction in the intervention group was significantly higher than in the preintervention group (P < 0.005), and a significant increase in sexual satisfaction was observed in the tetanus syrup group. Results: Taking T. terrestris syrup increased sexual satisfaction in postmenopausal women.
  535 71 -
Epistaxis as the initial presentation in a case of rheumatic heart disease
Monika Pathania, Vyas Kumar Rathaur, Archana James Pattupara, Swati Arya, Shashank Bansal, Nidhi Kaeley
September-October 2018, 7(5):1136-1138
DOI:10.4103/jfmpc.jfmpc_211_18  PMID:30598978
Rheumatic heart disease (RHD) remains prevalent in developing nations and shows varied presentations, causing diagnostic challenge. Here, we report a case of RHD in a 13-year-old boy who presented with recurrent epistaxis as the initial symptom. On detailed work-up, echocardiography revealed the incidental finding of involvement of mitral and aortic valves but the patient never had any symptom as per the diagnostic criteria for RHD. This report highlights the clinical and epidemiological significance of atypical presentations as such cases might go undiagnosed and untreated, seeking medical attention in advanced stages, which would have otherwise contributed to the actual prevalence of the disease in the population.
  564 35 -
Role of optimum diagnosis and treatment of insomnia in patients with hypertension and diabetes: A review
Himanshu Garg
September-October 2018, 7(5):876-883
DOI:10.4103/jfmpc.jfmpc_337_17  PMID:30598926
Sleep plays a pivotal role in regulation and function of the central nervous system (CNS) and other physiological functions of the body such as regulation of body temperature, metabolism, catabolism, learning, and memory consolidation. Therefore, sleep is not a mere passive state, but it is a highly organized interaction of neural networks and neurotransmitters of the CNS which maintain active neurobehavioral state. However, in insomnia normal physiological function is disturbed which results in several comorbidities such as depression, cardiovascular disorders, hypertension, diabetes mellitus, breathing difficulties, chronic pain, and gastrointestinal problems which affect the quality of life. Diagnosis of insomnia requires a comprehensive assessment of patient's medical history, physical examination, and sleeping pattern using various screen tools. There are several options available for the treatment of insomnia such as non-pharmacological and pharmacological that increase our understanding of the involvement of neurophysiological, neurobehavioral, neurochemical, neurocognitive, and neuroendocrine factors associated with insomnia. The pharmacological agents that are currently in use for the treatment of insomnia include benzodiazepines (BZDs), non-BZD hypnotics, and ramelteon as well as antidepressants such as doxepin. However, due to adverse events and addiction potential, use of BZDs is obsolete. Among non-BZD, zolpidem is the highly prescribed drug for the treatment of insomnia, globally. This review article focuses on prevalence, pathophysiology, diagnosis, and treatment of insomnia in patients with hypertension and diabetes. In addition, it also discusses the role of zolpidem in comparison to BZDs in the management of insomnia.
  520 73 -
The prevalence and risk factors of diabetic retinopathy in selected primary care centers during the 3-year screening intervals
Sultan F Magliah, Wedad Bardisi, Maha Al Attah, Manal M Khorsheed
September-October 2018, 7(5):975-981
DOI:10.4103/jfmpc.jfmpc_85_18  PMID:30598943
Objectives: This study aimed to determine the prevalence and progression of diabetic retinopathy (DR) and its risk factors in patients with diabetes attending primary care centers. Methods: This study was a cross-sectional chart review that was conducted in three randomly selected primary care centers. A total of 250 patients with diabetes had three consecutive annual screenings for DR from April 2014 to April 2017. At the initial visit, the ophthalmological findings were recorded. For three successive yearly screening, the screening results were assessed to estimate the changes that occurred in the prevalence, incidence, and progression of DR in addition to the degree of association with the most predictable risk factors. Results: The initial prevalence of DR was 15.2%. In this study, the findings over three consecutive screening intervals revealed that there was a steady increase in the prevalence of DR. The findings of this study showed that there was no significant association with DR and known risk factors including sex, type of diabetes mellitus (DM), obesity, and smoking. On the other hand, the duration of DM, hemoglobin A1c level, uncontrolled diabetes, hypertension, dyslipidemia, nephropathy, insulin treatment, and age were identified as strong predictors of DR among diabetics in this study. Conclusion: DR, a serious microvascular complication of DM, is an asymptomatic disease with a slow onset and gradual progression. Primary prevention is highly recommended to control the risk factors that will delay the onset and progression of DR.
  488 81 -
Economic impact of chronic obstructive pulmonary disease: A cross-sectional study at teaching hospital in South India
Theophilus Lakiang, N Sreekumaran Nair, Aarthy Ramaswamy, Umang Singhal
September-October 2018, 7(5):1002-1006
DOI:10.4103/jfmpc.jfmpc_75_16  PMID:30598947
Background: Chronic obstructive pulmonary disease continues to be the important contribution toward disability, death, and burden in the costs of health care globally. Economic impact of COPD is attributed with substantial direct and indirect costs. COPD affects the productivity of work that poses a burden on the employers and also on individuals in terms of loss of pay, limitation of activities, and related disability. Materials and Methods: Hospital-based cross-sectional study among 24 respondents in selected hospital in Udupi Taluk. Respondents were identified by purposive sampling technique and data were collected in respondent's mother tongue. An interviewer administered questionnaire was used to collect data related to patient's demographic status, disease history, and direct and indirect costs of COPD. Data were analyzed using SPSS software version 15. Results: The mean total direct medical cost that was observed among 24 respondents was Rs. 29,885 ± 11,995.33 and the mean total direct nonmedical cost was Rs. 7,441.25 ± 2,228.90. The mean total direct medical costs of COPD patients with comorbidity were Rs. 28,148.2353 ± 2,578.01580 and for those without comorbid illness was Rs. 13,460.0000 ± 1,255.33528. The observed mean absenteeism in the past 28 days was 193.50 ± 33.62 h. The mean absolute presenteeism of respondents is 72.05 ± 7.55. Conclusions: The major drivers of the total cost were cost of hospitalizations and medication costs. Acknowledging the costs and economic impact of COPD is therefore extremely important in the management of COPD and in reducing the mortality and morbidity related to COPD and in improving adherence to treatment.
  504 60 -
Collaborative global health E-learning: A Massive Open Online Course experience of young family doctors
Kyle Hoedebecke, Mohammad Mahmoud, Kenneth Yakubu, Candan Kendir, Rosanna D'Addosio, Maria Bakola, Tasneem Borhany, Osunsanya Oladunni, Ana Kareli, Ozden Gokdemir, Yusianmar Mariani, Joana Guerra da Costa e Silva, Maria João Nobre, Ivana Babic, Yasmin Córdova, Isabella Vanorio Vega
September-October 2018, 7(5):884-887
DOI:10.4103/jfmpc.jfmpc_186_18  PMID:30598927
Massive Open Online Courses (MOOCs) are unlimited web-based courses accessed through computers, smartphones, or other digital devices. Although they have multiple advantages, a common challenge is the low course completion rates. Young family doctors of the World Organization of Family Doctors (WONCA) from more than 20 countries recently completed an initiative that combined social media platforms with a MOOC offered by Harvard University. This resulted in a completion rate five times greater than the baseline rate. We propose perfecting and expanding this method to augment continued medical education, collaboration, and best practice exchange among WONCA's members and participating organizations worldwide.
  516 45 -
Primarycare teams and recent experiments towards population coverage in India
Ramandeep S Gambhir, Raman Kumar, Amit Aggarwal, Richa Goel, Samir Anand, Arvind Bhardwaj
September-October 2018, 7(5):845-851
DOI:10.4103/jfmpc.jfmpc_49_18  PMID:30598922
Many people in India, especially the poor, face the hurdle of seeking effective health care at an affordable cost, at a distance they can travel, and with the dignity they deserve. According to reports from across the world, it is evident that countries having a strong primary health care system, have better health outcomes, lower inequalities, and lower costs of care. Primary care requires a team of health professionals, workers, and volunteers having a judicious skill mix. Some initiatives have been taken by the government in states like Kerala, Assam, Chhattisgarh, etc., to strengthen the primary health care infrastructure and provide primary care as close to their homes as possible. Staff deficiencies were addressed and training was also provided to the untrained staff. The current review focuses on several other primary care organizations that are working in different parts of the country (rural and urban), for e.g. Healthspring, MeraDoctor, Swasth India, Rashtriya Swasthya Bima Yojna (RSBY) Outpatient Pilot Program, etc. The current review also throws spot light on the type of primary health care system existing in countries like China, South Africa and Brazil. Some lacunae in service delivery are also identified and addressed so that changes can be incorporated at the policy and program level.
  494 61 -
Knowledge of umbilical cord blood banking among obstetricians and mothers in Anand and Kheda District, India
Ayushi A Mistry, Amee A Amin, Somashekhar M Nimbalkar, Pranav Bhadesia, Darshak R Patel, Ajay G Phatak
September-October 2018, 7(5):1032-1036
DOI:10.4103/jfmpc.jfmpc_147_18  PMID:30598952
Background: To assess the knowledge of obstetricians and expectant mothers towards UCB banking and their awareness regarding pros and cons of the process. Methods: Questionnaires from a previously published study were modified contextually and translated into vernacular language (Gujarati). The questionnaires were distributed among 200 obstetricians, of which 100 responded and 100 mothers were in Anand and Kheda districts of India. Informed consent was taken for both. Results: Mean (SD) age of obstetricians was 47.5 years (11.14) with mean (SD) work experience of 19.72 years (9.94). Almost all were aware of collection procedure for UCB and felt that UCB banking is useful. Thirty obstetricians thought that stored blood can be used in conditions of Autism, Duchenne Muscular Dystrophy and all genetic conditions. Sixty-three were aware of the procedure technique. Majority felt that the process was feasible and would do it for their own child. All the 100 mothers approached consented for the study with average age (SD) of 26.88 (4.17). Many were not aware of such a procedure and were not certain about the usefulness of the procedure. Seventy-six did not know the conditions in which the stored blood can be used. Only 4 mothers/family members had opted for UCB banking, whereas 27 expressed their willingness to recommend UCB to another mother. Five Muslim women wanted UCB but could not pursue it due to religious norms. Conclusion: The level of understanding among obstetricians was not commensurate with the amount of faith with which they promoted UCB banking.
  505 40 -
Awareness of folic acid use among Saudi women attending outpatient clinics at King Fahad Medical City
Fatmah F Alreshidi, Ahmad S Almujil, Alharbi S Malak
September-October 2018, 7(5):957-962
DOI:10.4103/jfmpc.jfmpc_174_18  PMID:30598940
Context: Women should consume folic acid (FA) during pregnancy to prevent neural tube defects (NTDs) in their children. Awareness of FA use, dosage, and administration can affect the risk of child malformations and other pregnancy complications. Aims: The primary objective of this study was to assess knowledge about the role of FA intake among Saudi women of reproductive age. The secondary objective was to ascertain the use of FA supplements in Saudi Arabia and the age of gestation at which FA is taken. Settings and Design: This cross-sectional study used a simple random sampling method for selecting Saudi women attending outpatient clinics at King Fahad Medical City in Riyadh, Saudi Arabia. Materials and Methods: A random sample of 600 Saudi women aged 18–45 years was evaluated for their awareness of FA use. Participants completed a questionnaire comprising 16 questions. Six questions were demographic, and the remaining 10 fulfilled the study aims. Results: Women had high awareness about FA. Survey responses showed that 42.2% of women knew that FA should be taken before pregnancy, and 80.1% were aware that it prevents NTDs. A total of 46.8% women took FA during preconception. Healthcare professionals provided the information in 69.7% of the cases. Conclusion: We concluded that the lower number of deformities in Saudi Arabia is due to greater awareness of the importance of FA, which can likely be attributed to better education. Doctors and nurses should continue to encourage women to take FA supplements when planning their pregnancies.
  466 71 -
Dermatoses of nipple as molluscum contagiosum – Clinical dilemma
Puneet K Agarwal, Chirag S Dausage
September-October 2018, 7(5):1100-1102
DOI:10.4103/jfmpc.jfmpc_126_18  PMID:30598967
Molluscum contagiosum is a very common skin and mucosal disease of viral origin, caused by molluscum contagiosum virus (MCV) 0 of poxvirus family. With the eradication of smallpox, MCV is the only member of the poxvirus family that causes substantial disease in humans. Although frequently reported, its unusual clinical presentation makes its diagnosis a challenging task.
  496 34 -
Visual acuity and refractive changes among pregnant women in Enugu, Southeast Nigeria
Z Nwachukwu Nkiru, Okoye Obiekwe, Okwesili Lilian, C Nwachukwu Daniel, I Nwagha Uchenna, Umeh Rich
September-October 2018, 7(5):1037-1041
DOI:10.4103/jfmpc.jfmpc_335_17  PMID:30598953
Introduction: Pregnancy has been associated with changes in the eye which could be physiological, pathological, or exacerbation of pre-existing ocular conditions. Visual acuity (VA) and refractive error (RE) changes are part of the physiological changes that may occur during pregnancy. Objective: The objective of the present study was to investigate changes in VA and RE across two different trimesters and six weeks postpartum among pregnant women in Enugu, southeast, Nigeria. Materials and Methods: A longitudinal study was adopted and pregnant women in their second trimester attending antenatal clinic at University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu were consecutively recruited. A questionnaire was used to obtain information on their sociodemographic and clinical characteristics. Visual acuity was measured and refractive error monitored in second and third trimesters and 6 weeks after delivery. Results: The mean age of women was 30.81 (±5.49) years and a majority of them were civil servants. There was a worsening of VA for distance in more women in the third trimesters compared to the second trimester. There was no significant change in VA for near throughout the study period. There was an increased myopic shift in more pregnant women during the third trimester (40; 40.0%) compared to second trimester (36; 36.0%). The most common refractive error found among the women was simple myopia. These changes resolved six weeks postpartum. Conclusion: Pregnancy worsened VA for distance and the most common RE in pregnant women was simple myopia. However, these changes resolved during the postpartum period.
  481 46 -
The effectiveness of mobile phone text massaging support for mothers with postpartum depression: A clinical before and after study
Sara Niksalehi, Mohsen Taghadosi, Fereshte Mazhariazad, Monavar Tashk
September-October 2018, 7(5):1058-1062
DOI:10.4103/jfmpc.jfmpc_120_17  PMID:30598957
Background: It is estimated that postpartum depression (PPD) occurs in 10–15% of women in the year after childbirth. The highest number of women with PPD has limited access to psychosocial and pharmacological interventions. Long-distance counseling via mobile phone might be useful for the treatment of women with PPD, specifically in regions with low socioeconomical status and rural areas. Objective: Due to the high prevalence of PPD and its effects on health status of mothers and babies, we aimed to determine whether long-distance counseling via mobile phone text messaging is efficacious for the treatment of mothers at PPD risk. Materials and Methods: This pre-test and post-test clinical study was conducted in 2014 on 54 women referred to hospital affiliated to Hormozgan University of Medical Sciences in the south of Iran. Data were collected twice (baseline and follow-up) through telephone interviews for assessing PPD risk of participants via the Edinburgh Postnatal Depression Scale (EPDS). The participants were recontacted by phone within 14 days after their childbirth. Women at PPD risk (EPDS ≥12) were included in the study to receive daily text messages and others were excluded. Each mother received two daily text messages via mobile phones for 35 days. The data were analyzed using SPSS 16. Results: The average age of participants was 27.27 (range 17–35). Findings revealed that sending text messages to women with PPD would decline PPD. At pre-test, the average score for PPD was 14.44 (SD = 2.66) and it was declined to 11.94 (SD = 2.49) at the post-test phase. There was a significant difference between pre-test and post-test evaluations (P-value < 001). Conclusions: Long-distance counseling through sending text messages to patients with PPD can be an effective treatment along with other current treatments. This can improve mothers' health literacy about maternal postpartum psychological disorders.
  457 69 -
Formulating a model for the relationship between alexithymia, social support, loneliness, and marital satisfaction: Path analysis model
Mojgan Shariat Panahi, Aliasghar Hoseinzadeh, Mehdi Razaghpour, Nasrin Hosieni
September-October 2018, 7(5):1068-1073
DOI:10.4103/jfmpc.jfmpc_3_18  PMID:30598959
Aim: The present study was conducted in order to develop a relationship model of alexithymia, social support, loneliness, and marital satisfaction. Methods: One hundred eight couples who were parents of beginner students who participated in the assessment plan at the entrance to the primary school of Mahmoud Abad from Iran were selected using the accessible method to participate in this study; these couples completed self-reported questionnaires of alexithymia, social support, loneliness, and the Enrich's Couple Scales. Results: Findings showed that social support has a direct positive effect on marital satisfaction; additionally, alexithymia and social support have an indirect significant impact on marital satisfaction. Conclusion: The study provided additional evidence of the importance of alexithymia, social support, and loneliness in marital satisfaction.
  474 50 -
The effect of herbal tea capsule on menopause hot flashes
Masoomeh Kheirkhah, Shaghaiegh Dehghan Naieri, Naghme Shahbazi Tabari
September-October 2018, 7(5):1074-1078
DOI:10.4103/jfmpc.jfmpc_332_17  PMID:30598960
Background: Menopause, during which women experience many problems, including hot flashes, is a natural stage in the life of women. One of the duties of midwives is the promotion of women's health during menopause. Herbal remedies are well received and accepted by the community. This study was conducted to determine the effect of herbal tea capsule on hot flashes during menopause. Methods: The present randomized, clinical trial study was conducted on 82 women who complained of hot flashes during their menopause period. The samples were randomly divided into two groups, each including 41 subjects. One group received 450 mg of herbal extracts daily and the other group received starch gelatin capsules daily for 8 weeks. The capsules were similar in appearance. After the intervention, the mean hot flash score was determined using the registration form of the severity, duration, and number of hot flashes before, 4, and 8 weeks after the intervention. Statistical analysis of collected data was conducted using t-test, Chi-square, Friedman, Wilcoxon, and Mann–Whitney tests. Results: The mean score of hot flashes, in the placebo group, was 0.62 ± 0.63 before intervention, 4.24 ± 3.26 four weeks after intervention, and 4.42 ± 1.93 eight weeks after intervention; in the herbal tea group, this rate turned out to be 1.65 ± 1.42 before intervention, 3.8 ± 1.36 four weeks after intervention, and 1.74 ± 4.88 eight weeks after intervention. Hence, there was a significant difference between the groups in terms of severity and duration of hot flashes. Conclusion: Taking herbal tea capsules for at least 1 month is recommended for treating hot flashes of women during pregnancy. It is recommended that these herbs be used as herbal supplement.
  463 54 -
Prevalence, clinical features, and diagnosis of Trichomonas vaginalis among female STI clinic attendees in Trinidad
Aruna K Divakaruni, Bisram Mahabir, FA Orrett, A Sneha Rao, A Srikanth, Vijay K Chattu, A V. C. Rao
September-October 2018, 7(5):1054-1057
DOI:10.4103/jfmpc.jfmpc_102_18  PMID:30598956
Background: Trichomonas vaginalis (TV) is one of the most common pathogens causing sexually transmitted infections (STIs) in both men and women. Since there are no accurate prevalence data available on TV infection among women for Trinidad and Tobago and in the Caribbean region, there is a great need for research to study the dynamics of the infection and its transmission. Objectives: To determine the prevalence and diagnose TV infection in women attending the STI clinic and to provide recommendations for control and prevention of trichomoniasis in the community. Study Design: A cross-sectional study was designed after obtaining the informed consent. Following a routine clinical examination, vaginal swabs were collected – one for wet mount preparation, one for InPouch culture, and other two for OSOM rapid test/and fluorescent antibody testing. Cotton swabs and Dacron swabs were used for testing. Results: A prevalence of 16% of trichomoniasis out of 422 females was recorded. In all, 65 (65%) were in the age range of 15–29 years and peak of 30% in the age group of 20–24 years. Vaginal discharge was a common complaint (83%); 75.6% had foul odor and only 9.8% had typical fishy odor. The majority of them (87%) had whitish-yellow colored discharge. Conclusion: Prevalence of trichomoniasis is significant in the female population attending STI clinic. Targeting high-risk age group between 15 and 29 years for control and prevention would be beneficial. Prompt and accurate diagnosis using appropriate laboratory test is recommended.
  464 53 -
Family-centric safe motherhood approach for marginalized young married couples in rural India
Sumitra Dhal Samanta, Gulnoza Usmanova, Anjum Shaheen, Murari Chandra, Sunil Mehra
September-October 2018, 7(5):852-858
DOI:10.4103/jfmpc.jfmpc_351_17  PMID:30598923
Background: India contributes high broaden of maternal and child death globally. Over the past decade, there has been considerably improvement in maternal and child health indicator in India with intervention of national health mission. However, inequalities in basic health outcomes, lack of access and poor quality of medical care still exists. Marginalized, poor, and rural populations have noticeable low health indicators. Aim: The aim of this study isto describe the design, implementation, and baseline findings of “family centric safe motherhood approach among marginalized young married couples in rural India. Settings and Design: To establish a baseline, we completed 1347 interviews in 100 villages from two rural blocks (Balotra and Siwana) of Rajasthan, India. Methods: The progress of health outcomes is to be measured by set of indicators. Based on results, intervention package was developed. Statistical Analysis Used: The data were entered in SPSS 22 version. Bivariate analysis was performed. Results: Around two-fifth of couples (42.9%) used any temporary contraceptive method. Although the percentage of antenatal care (ANC) in the first trimester (77%) was high, but only 10% of them received three or more ANC check-up. Institutional delivery was reported to be 64.5%. Less than 10% of the women reported that they received quality of ANC (7.1%) and 32.7% was tetanus vaccination coverage in the study area. Aware of any contraceptive method was above 92.7% and 64.3% of respondents have an intention to use any family planning method in the next 12 months. Conclusions: These data provide a baseline of crucial information for evidence-based action on maternal and child health at rural inaccessible villages. Our baseline estimates will facilitate the evaluation of interventions and feasibility of scaling up of intervention.
  464 45 -
Burnout, job satisfaction, and anxiety-depression among family physicians: A cross-sectional study
Ahmet Yilmaz
September-October 2018, 7(5):952-956
DOI:10.4103/jfmpc.jfmpc_59_18  PMID:30598939
Introduction: Physicians are the most burn-outed group among the occupations. Among the physicians, family physicians have the highest burnout rates. Our objective in this study is to determine factors that are effective on work satisfaction of family physicians and their correlations with their burnout, anxiety-depression levels. Subjects and Methods: This cross-sectional descriptive study was carried out in primary health care professionals in region of Southeastern Anatolia from Diyarbakır Turkey. A survey form consists of 74 questions, and which questions burnout, job satisfaction, and anxiety-depression level has been applied on family medicine doctors, supplementary items in a questionnaire. Total of 343 family medicine doctors were reached, and the questionnaires were administered by face-to-face interview. Statistical Package for Social Sciences for Windows 18.0 software was used for statistical analysis. Results: Work satisfaction of family physicians who are on call lower compared to doctors who are not on call among family physicians who have joined to study (P < 0.005). It is determined that there is negative correlation between work satisfaction level of family physicians and emotional burnout, desensitisation, anxiety and depression point (P = 0.001 r = -0.23, P = 0.015, r = -0.16, P = 0.06, r = -0.124, P = 0.0001, r = -0.23), there is positive correlation between emotional burnout levels and anxiety, depression average points (P = 0.001, r = 0.34, P = 0.0001, r = 0.41), there is positive correlation between anxiety and depression points (P = 0.0001, r = 0.57). Conclusion: The work satisfaction level of family physicians, who are on call and whose financial income expectation is not satisfied, was found low. It is seen that there is strong correlation between inadequacy of work satisfaction with burnout and anxiety, depression. As this can have negative effects on work performance, there is a need to look for solutions to increase work performance of family physicians.
  434 75 -
Comparative evaluation of the effects of BLES and Survanta on treatment of respiratory distress syndrome in newborns
Ali Aghayar Macooie, Zahra Fakour, Paria Roanaghi
September-October 2018, 7(5):1063-1067
DOI:10.4103/jfmpc.jfmpc_188_17  PMID:30598958
Background and Objectives: Symptoms of respiratory distress syndrome (RDS), which is inverse correlation with gestational age and birth weight, occur in premature infants and newborns. The main objective of the study is comparative evaluation of the effects of BLES and Survanta on treatment of RDS in newborns. Materials and Methods: In all, 100 patients were randomly divided into two groups of 50 subjects in this study. While the group receiving BLES included 32 (64%) male and 18 (36%) female infants, there were 29 (58%) male and 51 (52%) female infants in the other group which received Survanta. Results: Although the results of this study showed improvement in respiratory status based on Downes scoring system in both groups after receiving surfactant, there was no significant difference in terms of short-term respiratory enhancement based on Downes scoring system among two groups. Pulmonary hemorrhage was the most frequent complication, with five cases (10%), among infants in BLES group; with five cases, pneumonia was the most observed complication in the group receiving Survanta. No significant difference in terms of complication was observed between two groups (P = 0.438); there was no significant difference in terms of mortality among two groups (P = 0.828). Conclusion: Both groups experienced respiratory status enhancement after receiving surfactant and the results of arterial blood gas (ABG) showed positive effects and efficiency of both drugs. Lack of significant difference in the effects of two mentioned drugs, BLES and Survanta, can be the main cause behind the absence of significant difference between two groups in terms of changes in respiratory status or ABG in newborns. No significant difference was observed in terms of complication between two groups, indicating lack of difference in the effects of medicines injected for infants suffering from RDS.
  442 65 -
Chronic multifocal osteomyelitis: A rare presentation of melioidosis
Vijay Alexander, Maria Koshy, Rachana Shenoy, Thambu David Sudarsanam
September-October 2018, 7(5):1133-1135
DOI:10.4103/jfmpc.jfmpc_227_18  PMID:30598977
A 45-year-old gentleman presented with fever, weight loss, and painful swelling of both knees. His history was significant for type 2 diabetes mellitus. Blood cultures grew Burkholderia pseudomallei, and imaging revealed osteomyelitis of bilateral distal femura and proximal tibiae, with no involvement of the joint space. He underwent debridement and was initiated on ceftazidime followed by eradication therapy with trimethoprim–sulfamethoxazole. He recovered well with no further complications. Melioidosis is a rare cause of multifocal osteomyelitis and is a differential to be considered in an appropriate clinicoepidemiological setting.
  453 50 -
Efficiency of diet change in irritable bowel syndrome
Bandar Mohammed Bardisi, Abdulaziz Kamal H Halawani, Hassan Kamal H Halawani, Aseel Hassan Alharbi, Nesma Saleh Turkostany, Taraji Saeed Alrehaili, Aisha Ahmad Radin, Nasser Moqbil Alkhuzea
September-October 2018, 7(5):946-951
DOI:10.4103/jfmpc.jfmpc_173_18  PMID:30598938
Background: Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder characterized by symptoms of abdominal pain, bloating, and altered bowel habit such as constipation, diarrhea, or both. Food is one of the most commonly reported triggers of IBS symptoms. we aim to assess the effect of diet change in improving IBS. Methods: This study was a cross-sectional study. A questionnaire was developed for data collection in the present study. The survey was distributed online in Arabic language. Results: A total of 1202 subjects participated in our study. Of these, 685 (57%) were female patients and 517 (43%) were male patients. The age of patients ranged from 15 to 55 years, more than one-third of them located in the age range between 15 and 25. The statistical analysis reported a significant correlations between having IBS for three successive days for 3 months regarding age and duration of IBS (P value <0.001), having depression or anxiety before, and if the depression affects IBS symptoms or not (P value = 0.013 and <0.001, respectively). Having dietary regimen, advising to increase fibers, thinking about changing diet improves IBS symptoms (P value = 0.001, 0.005, and < 0.001, respectively) and having treatment (P value = 0.006). Conclusion: According to our results, the prevalence of IBS was higher among females. Some diets, especially onions, garlic, and coffee, were reported to increase the IBS symptoms. Decreasing carbohydrate diets and increasing fiber diet would enhance the patient health where the symptoms where decreased.
  433 65 -
Congenital dermal sinus with extensive intramedullary expansion and an infected spinal epidermoid cyst in an infant
Saugata Acharyya, Sanchari Chakravarty
September-October 2018, 7(5):1103-1105
DOI:10.4103/jfmpc.jfmpc_158_18  PMID:30598968
An 11-month-old female child presented with progressive weakness involving both lower limbs and left upper limb. There was hypertonia and hyperreflexia in the affected limbs. This was associated with multiple episodes of urinary tract infection and overflow incontinence of the urinary bladder. Magnetic resonance imaging of the spine revealed extensive intramedullary expansion of a congenital dermal sinus. There was a cystic lesion along the lower end of the sinus tract. Surgical exploration had confirmed the presence of an infected epidermoid cyst along with the dermal sinus tract. The entire tract as well as the abscessed epidermoid cyst was removed. Following this, the child showed gradual improvement of neurological function and bladder dysfunction. This is perhaps the first report in current literature of a congenital dermal sinus tract with such an extensive intramedullary extension (almost the entire spine) and an infected epidermoid tumor in an infant.
  454 42 -
A painful anal lesion
Morteza Khodaee, Roxanne L Radi
September-October 2018, 7(5):1139-1140
DOI:10.4103/jfmpc.jfmpc_150_17  PMID:30598979
  463 32 -
Pattern of sexually transmitted infections: A profile from a rural- and tribal-based sexually transmitted infections clinic of a tertiary care hospital of Eastern India
Somenath Sarkar, Aparesh Chandra Patra, P Srinivas, Arghyaprasun Ghosh, Ganesh Kushbaha, Supratim Saha
September-October 2018, 7(5):1042-1046
DOI:10.4103/jfmpc.jfmpc_80_17  PMID:30598954
Introduction: Prevalence of Sexually transmitted infections (STI's) in developing nations is very high where the measures for STI treatment and prevention are limited. Enormous variation in clinical presentation make STI's very difficult to be studied epidemiologically. To know the exact prevalence of STI's is very important for a region or community for planning preventive strategies. The aim of the present study is to observe the pattern of sexually transmitted infections among the tribal and non-tribal population attending a rural and tribal base tertiary care Centre. Method: All the consecutive STI patients irrespective of age and sex attending the STI clinic were included. Thorough clinical examination and relevant investigations were done to know the different STI's present in them. They were divided into tribal and non-tribal group as per history and comparison of patterns of STI's done among the two groups. Result: Around 34% of STI patients were tribal. Majority of patients belong to 20-40 years of age. Sex ratio of tribal group was 1:0.86 and non-tribal group was 1:2.64. The difference is statistically significant. Commonest STI in both the group was Genital ulcer disease Herpetic but the occurrence of urethral discharge, genital scabies, and inguinal bubo were among the tribal group. Per vaginal discharge was the commonest STI among the female in both the groups. VDRL positivity was 1.16% and HIV positivity was 0.36% among STI clinic attendees. Conclusion: Tribal females need special attention for prevention of STI in tribal community.
  449 41 -
Internet use for patient care and health research: A cross-sectional study among physicians in a teaching hospital of Eastern India
Sanchit Bhatia, Lipilekha Patnaik, Sumitra Pattanaik, Trilochan Sahu
September-October 2018, 7(5):993-997
DOI:10.4103/jfmpc.jfmpc_262_17  PMID:30598945
Background: Internet is the world's largest network of information and communication services. The internet is widely used in medicine and had a significant impact on research, training, and patient care. Objectives: (1) To assess internet use to obtain health information for patient care among physicians of a medical college hospital. (2) To investigate the utilization of the internet during their daily practice and to know the reasons for its use and nonuse. Materials and Methods: A hospital-based cross-sectional study was conducted for a period of 2 months of May and June 2015 in a Medical College Hospital of Eastern India. A convenient sample of 200 physicians was included in the study. Data regarding access of internet in workplace, time spent on the internet for medical and nonmedical purposes, opinions regarding use of the internet to update medical knowledge, obstacles that affect its use, etc., were collected. The data were analyzed using SPSS software version 20. Results: It was seen that 47% doctors use laptop for accessing internet, followed by mobiles (34%). E-mail was the main purpose (41%) of internet use, followed by research (32.5%). Majority told that e-mail was the main purpose of last internet use (46.5%), followed by browsing medical resources (23%), research (15.5%), and patient care (12.5%). 97.5% agreed that they had ever browsed internet for patient care and 85.5% doctors agreed that they had obtained relevant information. 26.5% told that they need training for accessing free full-text electronic journals and 25% need training to access the sources for best clinical evidence for patient care. Other training needs were literature search (18%), downloading textbooks and other resources (15.5%), and searching internet sites for medical information (10%). Conclusion: Providing training for improvement of searching skills for obtaining up-to-date medical information, and evidence-based medicine from internet will improve their practice of medicine.
  431 41 -
The effect of blended training on the quality of life of children with nephrotic syndrome
Sedighe Khanjari, Sedighe Jahanian, Hamid Haghani
September-October 2018, 7(5):921-926
DOI:10.4103/jfmpc.jfmpc_176_18  PMID:30598934
Background: Nephrotic syndrome is a common nephrology disorder in children that can affect the quality of health of children and adolescents significantly. Training children with nephrotic syndrome with special emphasis on the use of blended training can provide new opportunities for improving the quality of life of these subjects. The present study was conducted in order to investigate the effect of blended training on quality of life in children with nephrotic syndrome. Materials and Methods: The present non-randomized clinical trial was carried out, in a time period from January 2012 to June 2013, on 76 children aged 8–12 years with nephrotic syndrome; the subjects were through continuous sampling. The intervention group subjects were selected from the Ali Asghar and Pediatric Medical Centers and the control group subjects were selected from the Mofid Hospital of Tehran. The control group received only previous routine interventions, but the intervention group, in addition to previous routine interventions, received part of the training for nephrotic syndrome. The Pediatric Quality of Life InventoryTM 4.0 (generic core scales) questionnaire was implemented in the present study. Collected data were analyzed by the SPSS 21; t-test and paired t-test were used to compare the mean scores of the two groups. Results: There was no significant difference between the two groups in terms of quality of life before intervention; but, the quality of life of the intervention group increased to the control group after intervention (P-value < 0.001). Conclusion: Blended training can improve the quality of life of children with chronic diseases. Therefore, it is recommended to carry out educational intervention for parents of these children in order to increase their coping skills.
  413 56 -
Prevalence of nocturnal enuresis among children in Primary Health Care Centers of Family and Community Medicine, PSMMC, Riyadh City, KSA
Abdullah Alshahrani, Mohie Selim, Mostafa Abbas
September-October 2018, 7(5):937-941
DOI:10.4103/jfmpc.jfmpc_32_18  PMID:30598936
Background: Nocturnal enuresis (NE) is commonly known as any intermittent incontinence while asleep in a child being at least 5-year old. The families of the children having this disorder can be greatly worried because this disorder can lead to considerable emotional distress and some psychological consequences. This study is aimed to estimate the prevalence of NE among children and to identify the characteristics of children who has NE. The third aim is to identify the consultation pattern to solve this problem. Methods: A cross-sectional survey was performed in Primary Health Care Centers of Family and Community Medicine, PSMMC, Riyadh City, KSA, during 2017. Results: Out of 65 families that have children with NE, 38.7% was the frequency of bedwetting every night; 22.6% of the children were stressed as a result of new child birth; 14% of the families did not feel a family load of having children with NE; 29% of the families did not try to treat their children because of their improvement with time; and 12% of the families that tried to treat their children used fluid restriction and waked their children up frequently at night. Conclusions: The prevalence of NE was 18.5% among families with a higher prevalence in boys. Prevalence of NE decreased with increasing age with many children found of having stressful events in their life other than parents' divorce. We would like to refer that it is important for families that have children with NE to seek medical consultation immediately, which can lead to behavioral modifications.
  408 56 -
Hematological malignancies presenting as spontaneous tumor lysis syndrome: A case series
Shehla Basheer Kollathodi, Kavitha Kanjirakadu Parameswaran, Lilly Madhavan, Shalini Kuruvilla
September-October 2018, 7(5):1116-1119
DOI:10.4103/jfmpc.jfmpc_171_18  PMID:30598972
Tumor lysis syndrome is an oncological emergency caused by massive tumor lysis resulting in a constellation of metabolic abnormalities. It is observed most frequently in patients with high-grade hematological malignancies undergoing treatment. Tumor lysis syndrome can occur spontaneously and it can present as the first symptom of an underlying malignancy. Diagnosis should be considered if specific metabolic abnormalities are present even in the absence of previously diagnosed malignancy. We report three unusual cases of hematological malignancies, rare in view of the primary disease as well as its presentation as spontaneous tumor lysis syndrome where a high index of suspicion led to the final diagnosis.
  393 52 -
Attitudes of patients' relatives in the end stage of life about do not resuscitate order
Mozhdeh Tajari, Rostam Jalali, Kamran Vafaee
September-October 2018, 7(5):916-920
DOI:10.4103/jfmpc.jfmpc_144_18  PMID:30598933
Introduction and Objective: The do not resuscitate (DNR) order is a decision taken by the patient or other people about medical care in the end stages of life to prevent resuscitation from causing cardiac or respiratory arrest. This study was conducted to evaluate the attitudes of patients' relatives in the end stages about DNR order. Materials and Methods: In a cross-sectional study, 150 relatives of patients who had been prescribed DNR orders were included in the educational hospitals affiliated to the Kermanshah University of Medical Sciences. The data collection tool was a researcher-developed questionnaire consisting of 29 attitudes questions related to DNR orders. The data were collected and analyzed in the SPSS software version 19 using descriptive tests. Results: According to the results of present study, although the relatives of pationts consider doctors thoroughly responsible for making decision related with DNR, and follow their order either way, they strongly disagree with a single doctor making individual decision in this domain. They believe that the patient and their relatives should be engaged in this decision. Although most participants tended to stay as close as possible to the patients and engage in patient care. Conclusion: Given that there are a few studies in Iran on the attitudes of patients and their relatives about DNR, and there are no specific rules and guidelines in this regard. It is recommended that further studies be conducted on the subject. Engaging of patients and families in this important decision is necessary.
  387 55 -
Overnight pulse oximetry for obstructive sleep apnea screening among patients with snoring in primary care setting: Clinical case report
Lap-Kin Chiang
September-October 2018, 7(5):1086-1089
DOI:10.4103/jfmpc.jfmpc_142_18  PMID:30598963
This clinical case report illustrated a typical patient presented with snoring in the primary care. He was screened positive for obstructive sleep apnea (OSA) by overnight pulse oximetry and then referred to respiratory specialist care. With early confirmation and treatment of OSA, symptoms and comorbidity associated with OSA can be improved and risk for cardiovascular complication can be prevented. Among 264 cohort patients presented primarily with snoring in one primary care clinic of Hong Kong, 175 patients (66.2%) were screened to have OSA. About 56.0% (98/175), 26.2% (46/175), and 17.8% (31/175) were classified as mild, moderate, and severe OSA, respectively. In view of high prevalence of OSA among snorers, and OSA-related exacerbation in comorbid conditions and increased risk of cardiovascular complication, there is a need to stimulate OSA screening among snoring patients in primary care.
  381 58 -
Multiple impacted permanent teeth, an indicator for early detection of hypoparathyroidism: A rare case report
G Santosh Reddy, KV Chalapathi, D Santhosh Reddy, Subhrajit Rana, M Kalyan, B Kartheeki, Abhishek Singh Nayyar
September-October 2018, 7(5):1096-1099
DOI:10.4103/jfmpc.jfmpc_352_17  PMID:30598966
Eruption is a process of continuous movement of the developing tooth bud from its developmental location to functional location. Teeth that cease to erupt before emergence to their functional position in the oral cavity are termed as impactions. In permanent dentition, third molars are the most frequently impacted teeth followed by the canines. When impaction involves few teeth, the condition is localized but when it involves multiple teeth, the condition becomes generalized and is often associated with some derangement of the normal physiological processes. Factors causing impactions may be localized, pertaining to the area or, systemic or, generalized including bone disorders such as cleidocranial dysplasia and/or some sort of endocrinological disturbance such as hypoparathyroidism. Hypoparathyroidism is a rare endocrinological disorder accompanied by anomalies of various systems including bones and teeth. The dental defects due to hypoparathyroidism may present as hypocalcemia, aplasia and/or hypoplasia, defects of mineralization, short and blunted roots, delayed eruptions, and clinically missing or impacted teeth. This report describes an interesting and unusual case where multiple impacted permanent teeth and retained primary teeth accompanied by other clinical manifestations in a 16-year-old female patient probed the clinicians for further investigations which, eventually, aided in early diagnosis of hypoparathyroidism.
  380 56 -
Home visits: A new screening tool for frailty? A retrospective exploratory study
David Attwood, Kara Stevens, Lindsay Jones, Lucinda Harris, Fiona Roberts
September-October 2018, 7(5):1007-1011
DOI:10.4103/jfmpc.jfmpc_159_18  PMID:30598948
Background: In the United Kingdom, the new NHS contract for primary care mandates that practices use the Electronic Frailty Index (EFI) to screen for frailty and apply clinical judgment, based on knowledge of the patient, to decide whether they have a diagnosis of frailty. EFI has not yet been validated for this purpose. Many primary care clinicians would agree that although not formally investigated, there seems to be a strong association between being housebound or in institutional care and having a diagnosis of frailty. Although being housebound or in institutional care is not commonly coded in primary care computer record systems (IT), this cohort of patients do require home visits if they become unwell. Home visits are coded and it is simple to run a search on primary care IT to generate a list of older people who have received a home over given period. Aim: This study assessed whether being housebound and requiring home visits could form a new screening tool for frailty. Design and Setting: Retrospective cohort study from 1/3/15 to 29/2/16. Primary care, South Devon. Method: Medical records of 154 patients over 65 years of age were evaluated. Patients were divided into two groups: a group (n = 82) that had received a home visit and a second group consisting of a randomized sample of patients (n = 72) with similar baseline characteristics who had not. Patient records were analyzed by two clinicians to determine whether a frailty syndrome was present. Researchers were blinded to each other's results. An arbitrator determined the frailty status on disagreement. Results: Home visits have a sensitivity of 87.23% [95% confidence interval (CI): 74.35%–95.17%] and specificity of 61.68% (95% CI: 51.78%–70.92%). For frailty, Cohen's Kappa showed fair interobserver reliability. Conclusion: This study suggests that home visits are a good screen for frailty; the data are easy to retrieve from primary care IT and could be used as a valid screening tool to assist with identifying frailty in primary care.
  367 55 -
Determinants of family medicine physicians' knowledge and application of asthma management guidelines at primary healthcare centers in Riyadh, Saudi Arabia
Abdulaziz M Alrabiah, Tarek Elsaid, Ayla Tourkmani
September-October 2018, 7(5):927-936
DOI:10.4103/jfmpc.jfmpc_189_18  PMID:30598935
Background: The level of uncontrolled asthma is still high despite the availability of effective treatments and evidence-based guidelines for controlling asthma. Knowledge and adherence to evidence-based guidelines among care providers are crucial to the treatment. Objective: To investigate the determinants of family physicians' knowledge and application of asthma management guidelines at primary healthcare setting in Saudi Arabia. Methods: This is a cross-sectional study, conducted at 18 primary healthcare centers in Riyadh, Saudi Arabia. The sample consisted of 246 physicians. A self-administrated questionnaire was distributed among the physicians. The questionnaire included demographic, job characteristics, knowledge of asthma guidelines, and application of asthma guidelines' questions about the essential items related to diagnosis and management of asthma according to the international/local guidelines. The minimum acceptable level for each knowledge and application of guidelines was defined as scoring 70% correct answers. Results: The results show very low level of knowledge of guidelines among physicians with 94.6% scoring below the acceptable knowledge level. The guidelines are applied below the acceptable level with 55.6% scoring below the cut-off point. Higher level of knowledge is associated with higher position of the physician (P = 0.006), qualification held by the physician, namely, MRCGP qualification vs. MBBS (P < 0.001), and the physician's experience, namely, 10–15 years of experience vs. less than 5 years (P = 0.01). The application of guidelines is associated with position of the physician (P = 0.041). Physicians with registrar position scored higher application for guidelines than general practitioners and senior house officers. Conclusion: Recognition of the low level of knowledge and application of guidelines among care providers and working toward minimizing this problem can be through education, training, and monitoring of application; this can potentially improve asthma control among patients.
  372 47 -
Seizure associated with olanzapine
NA Uvais, VS Sreeraj
September-October 2018, 7(5):1090-1092
DOI:10.4103/jfmpc.jfmpc_405_16  PMID:30598964
Atypical antipsychotics are known to be associated with electroencephalogram abnormalities. Olanzapine can lower seizure threshold and induce epileptiform discharges. However in patients on Olanzapine for the treatment of a primary psychiatric disorder, clinical seizure is a rare occurrence. We report the case of a 23-year-old female with mild mental retardation with schizophrenia with obsessive compulsive disorder who developed new-onset generalized tonic-clonic seizure probably due to Olanzapine. Electroencephalogram showed epileptiform discharges. The seizure risk associated with Olanzapine was reviewed.
  375 42 -
Intra-leiomyoma hemorrhage in postmenopausal woman presented with acute abdominal pain
Ibrahim A Abdelazim, Mohannad Abu-Faza, Gulmira Zhurabekova, Shikanova Svetlana, Bassam Nusair
September-October 2018, 7(5):1129-1132
DOI:10.4103/jfmpc.jfmpc_215_18  PMID:30598976
Intra-leiomyoma hemorrhage in postmenopausal woman is a very rare complication. This case report represents a case report of spontaneous hemorrhage inside the uterine leiomyoma in postmenopausal woman who presented with acute abdomen. A 55-year-old woman, multipara, postmenopausal for 7 years, known case of multiple fibroid uteruses, was presented to the emergency department of Ahmadi Hospital, Kuwait Oil Company, with acute abdominal pain and vomiting, without any reported trauma and/or associated vaginal bleeding. The studied woman was generally stable regarding her vital signs, her hemoglobin dropped from 12 to 10.2 g/dl. Abdominal examination revealed; palpable pelvi-abdominal mass firms in consistency with tenderness and guarding which provisionally support the diagnosis of degenerated fibroids or intra-leiomyoma hemorrhage. The diagnosis was confirmed by basic pelvi-abdominal ultrasound, followed by correction of the patient's general condition and total abdominal hysterectomy with bilateral salpingo-oophrectomy (TAHBSO). Bisected largest cystic fibroid showed brownish serous fluid inside with organized clotted hematoma which confirmed the diagnosis of intra-leiomyoma hemorrhage. Postoperatively, the studied woman received an unit of packed red blood cells for correction of the postoperative anemia and discharged from the hospital in good general condition for postoperative follow-up in the outpatients' department on iron tablets. This case report represents a rare complication of intra-leiomyoma hemorrhage in postmenopausal, diagnosed by the basic clinical and ultrasound findings. The case was managed by TAHBSO after correction of the general condition because of the increased risk of the sarcomatous changes of the uterine fibroid in postmenopausal women.
  375 37 -
Leprosy or sarcoidosis? A diagnostic dilemma!
Ram Malkani, Rusina Karia
September-October 2018, 7(5):1106-1108
DOI:10.4103/jfmpc.jfmpc_30_18  PMID:30598969
There are two important differentials for non-caseating granulomatous inflammatory tissue—leprosy and sarcoidosis—which presents a diagnostic challenge due to their histological similarities and specific geographical distribution. This article describes a rare presentation of systemic sarcoidosis called Heerfordt's syndrome with the triad of parotitis, uveitis, fever, and optional paralysis of facial nerve. This case was initially diagnosed as leprosy.
  365 29 -
Brugada phenocopy due to hypokalemia
Adrian Baranchuk, Pavel Antiperovitch, Byron H Gottschalk
September-October 2018, 7(5):1141-1142
DOI:10.4103/jfmpc.jfmpc_64_17  PMID:30598980
  301 93 -
The hazards of impacted alkaline battery in the nose
Viji Ramasamy, Sanjeeven Nadarajah
September-October 2018, 7(5):1083-1085
DOI:10.4103/jfmpc.jfmpc_47_18  PMID:30598962
A foreign body in the nose is a common referral dealt by the otolaryngologist on daily basis. Here we report a case of a 5-year-old girl who was referred from a primary care center with complaints of left nasal blockage and epistaxis along with foul smelling brownish discharge for 1-day duration. Nasal endoscopic examination of the left side of the nose revealed an impacted button battery at the cartilaginous portion of the nasal septum.
  357 34 -
Giant thymolipoma of mediastinum and neck – initially misdiagnosed as liposarcoma by core needle biopsy
Manouchehr Aghajanzadeh, Mohammad Reza Asgary, Alireza Mesbah, Hosein Hemmati, Mohammad Sadegh Esmaili Delshad, Pirouz Samidoust, Ghazaleh Hemmati
September-October 2018, 7(5):1079-1082
DOI:10.4103/jfmpc.jfmpc_228_17  PMID:30598961
Thymolipomas are rare benign tumors, constituting one of the differential diagnoses of an anterior mediastinal mass. These tumors may have an indolent, asymptomatic course, often achieving massive dimensions before presentation. When it is symptomatic, respiratory symptoms predominate. We report a case of thymolipoma in a 30-year-old male complaining of heaviness and constricting type of chest pain and neck swelling of 1-year duration. Computed tomography scan finding revealed a space-occupying lesion in the anterior mediastinum and extend to the right side of the mediastinum, neck, and left hemithorax. A sono-guided core needle biopsy was carried out which identified an atypical cell and was suspicious to liposarcoma. The tumor was completely excised through “posterolateral thoracotomy.” Postoperative histopathological examination confirmed the diagnosis of thymolipoma. This is the second case we have reported from our institution.
  334 48 -
Hyperglycaemia induced by isoniazid preventive therapy
Roshni Jhan Ganguly, Rahul R Abraham, Ramakrishna Prasad, Badakere C Rao
September-October 2018, 7(5):1123-1125
DOI:10.4103/jfmpc.jfmpc_197_18  PMID:30598974
We report the case of a HIV-positive patient with type 2 diabetes mellitus who presented with uncontrolled blood sugars after the initiation of prophylactic isoniazid (INH) therapy. INH is widely used for prophylaxis and treatment of tuberculosis (TB) around the world and INH-induced hyperglycaemia could be overlooked.
  342 35 -
Acute right bundle branch block due to pneumothorax
Manish Ruhela, Gaurav Khandelwal, Samiksha Gupta, Agam Bansal
September-October 2018, 7(5):1126-1128
DOI:10.4103/jfmpc.jfmpc_222_18  PMID:30598975
Changes in electrocardiogram (ECG) due to pneumothorax have been studied and are well described mainly in case of left-sided pneumothorax. Classic ECG finding in left-sided pneumothorax includes right-axis deviation, diminution of QRS complex, T-wave inversion, phasic R wave variation, and reduced R wave in precordial leads. There has been reported case of incomplete right bundle branch block (RBBB) in left-sided pneumothorax. We hereby report the first case of acute-onset complete RBBB due to left-sided pneumothorax in a young patient after blunt chest trauma from a motor vehicle accident. ECG findings revert back to normal after 1.5 h of decompression of pneumothorax. We summarize the possible mechanisms that could lead to this unusual finding on ECG. Pneumothorax can cause unusual ECG changes like in our case and should be kept in the list of differential diagnosis in appropriate clinical conditions.
  334 42 -
Look before you leap: A case series of conidiobolomycosis from the Indian subcontinent
Nitin Gupta, Rajeev Kumar, Prashant Ramteke, Manish Soneja
September-October 2018, 7(5):1113-1115
DOI:10.4103/jfmpc.jfmpc_167_18  PMID:30598971
Conidiobolomycosis is an extremely rare subcutaneous rhinofacial indolent infection caused by Conidiobolus coronatus and Conidiobolus incongruus. It is reported mainly from the tropical and subtropical parts of the world, mostly in form of isolated case reports or small case series. Two immunocompetent male patients presented to our center with indolent nasal swelling and features of nasal obstruction. They were treated outside with antibiotics and/or steroids and were referred to us with nonresolving symptoms. Both of them were diagnosed based on the characteristic histopathological findings and were successfully treated with saturated solution of potassium iodide. Conidiobolomycosis is an important differential in patients presenting with centrofacial swelling. Early suspicion and timely referral by the primary care physicians will help in early diagnosis and treatment of this disease.
  342 31 -
Loss to follow up during diagnosis of presumptive pulmonary tuberculosis at a tertiary care hospital
Star Pala, H Bhattacharya, KG Lynrah, Amrita Sarkar, Pallavi Boro, GK Medhi
September-October 2018, 7(5):942-945
DOI:10.4103/jfmpc.jfmpc_161_18  PMID:30598937
Background: Sputum microscopy is still used for diagnosis of drug-sensitive pulmonary tuberculosis (TB). Revised National Tuberculosis Control Program (TB programs) aims to rapidly diagnose and treat all cases of TB. The aim of this study is to find the proportion of loss to follow up during diagnosis of pulmonary TB after the patient reached hospital (was handed over sputum cups for sputum collection) from DOTS center after referral from respective outpatient department (OPD) at a tertiary care hospital. Methodology: Record-based data from designated microscopic center at a tertiary care hospital were collected regarding the number of patients who had been given sputum cup container for sputum collection for diagnosis of pulmonary TB referred from different OPDs from January to December 2015. Results: A total of 1518 presumptive patient for pulmonary TB had visited DOTS center after referral from different OPDs in the hospital for sputum examination during the above period. The loss to follow-up during diagnosis among presumptive pulmonary TB patient was 461 (30.04%), which was higher among those below 15 years of age. At this rate of loss to follow up of presumptive TB patient to submit sputum for diagnosis, it was estimated to be about 46 smear-positive pulmonary TB cases per year which will be missed out for diagnosis during the above period (considering sputum positivity rate is 10% in the hospital). The mean gap between sputum referral to submission of two sputum samples was 2.73 days (95% confidence interval 2.52–2.84) among those of submitted sputum for diagnosis. Conclusion: Approximately one-third of presumptive patient for pulmonary TB had loss to follow-up for diagnosis of TB even after consulting a doctor at a tertiary care hospital. There is a need to address this gap in diagnosis of pulmonary TB in this region.
  327 31 -
Attitudes toward the elderly among young family physicians in Turkey
Tugba Caliskan, Candan Kendir, Nil Tekin, Mehtap Kartal
September-October 2018, 7(5):998-1001
DOI:10.4103/jfmpc.jfmpc_277_17  PMID:30598946
Introduction: General practitioners'(GPs) role is important as they are easily accessible especially for elderly. Young GPs need to improve their attitudes toward the elderly so that they can be a part of solution for health problems of elderly in the future. The aim of this study is to determine attitudes of young GPs toward elderly by the University of California at Los Angeles Geriatrics Attitude Scale (UCLA-GAS). Methods: It is a cross-sectional study performed with questionnaires including UCLA-GAS. The study population was 260 young doctors (GP residents and GPs in their first 5 years after qualification). Statistical evaluation of the data included percentage, mean, and Kolmogorov–Smirnov test and analysis of variance test. Results: Of the participants, 58.1% (n = 151) were women, 35.4% (n = 94) of them were GPs, and the remaining were GP residents. The mean age was 31.30 ± 5.40 years (range = 24–55 years). The mean score of UCLA-GAS was 46.85 ± 5.63 (range = 30–61). Participants ≤30 years of age had significantly higher scores (47.70 ± 5.99) than age above 30 years (45.68 ± 4.89) (P = 0.003). There was no statistically significant difference between GP residents and GPs (P = 0.989) and between participants who had rotation in elderly healthcare service (n = 63) or not (n = 197) (P = 0.383). However, as the duration of work increased, the score of UCLA-GAS decreased significantly (r = −0.216, P < 0.001). Conclusion: Young doctors who were interested in elderly showed more positive attitude as expected. However, the ones who were older and worked longer had less positive attitude. It seems important to understand and prevent this unfavourable attitude with formal education system about elderly healthcare during residency.
  315 40 -
Professional satisfaction of family physicians working in primary healthcare centers: A comparison of two Saudi regions
Khalid Bawakid, Ola Abdul Rashid, Najlaa Mandoura, Hassan Bin Usman Shah, Kholood Mugharbel
September-October 2018, 7(5):1019-1025
DOI:10.4103/jfmpc.jfmpc_6_18  PMID:30598950
Introduction: As a new healthcare market force and first point of contact, family physicians (FPs) play a key role in healthcare delivery system. It is vital to understand issues that affect performance and satisfaction with their practices and working environment. The objectives of this study are to assess the level of professional satisfaction and to compare and identify the factors potentially associated with professional satisfaction/dissatisfaction among FPs of two regions. Materials and Methods: A comparative cross-sectional study on FPs working in primary healthcare centers under Ministry of Health was conducted in two regions (Jeddah and Eastern region) to assess job satisfaction and dissatisfaction among them. Validated close-ended questionnaire was emailed. Overall satisfaction along with the associated factors was identified. Chi-square and multivariate regression analyses were performed to test the association between job satisfaction and predictors. Results: A total of 237 FPs completed the survey and an overall 62% of them were satisfied. Male doctors were less in number yet more satisfied (71%). FPs of eastern region were slightly more satisfied (63.4%) when compared with 59.2% of Jeddah. Factors significantly associated with professional dissatisfaction included FPs having the opinion that they were not respected by community members [odds ratio (OR) 2.7, confidence interval (CI): 1.24–5.97, P = 0.012] and FPs' own perception of being inferior to other specialties (OR 13.59, CI: 4.98–37.07, P < 0.001). Conclusion: More than half of the FPs were professionally satisfied; however, the majority had perception of being inferior to other specialties. Improving self-esteem, working environment, and addressing other identified factors for dissatisfaction can help FPs overcome their stresses, leading to better healthcare delivery.
  322 33 -
Silent colonic perforation and enterocutaneous fistula by a ball point pen 13 years after ingestion in a patient with schizophrenia
Dheeraj Kattula, Stephen Amarjeet Jiwanmall, Balaji Srinivasa Sekaran, Somanatha Sharma
September-October 2018, 7(5):1093-1095
DOI:10.4103/jfmpc.jfmpc_132_18  PMID:30598965
Patients with mental illness do not get medical and surgical attention as required. Here is a case of poor, unemployed gentleman with an ulcer which was carefully evaluated and treated appropriately. The presentation is novel in many other ways. The object of size 6 × 2.5 cm usually does not cross the duodenum, but in his case an 11-cm long pen had reached the splenic flexure. It also had stayed dormant for over 13 years before causing complications. When the pen perforated the bowel, the patient is expected to present with acute abdomen, but in this case it presented as enterocutaneus fistula. This case is first of its kind in medical literature.
  332 20 -
Vitamin D deficiency: An emerging pandemic
Jogender Kumar, Arushi Yadav, Kanhaiya Agrawal
September-October 2018, 7(5):1146-1147
DOI:10.4103/jfmpc.jfmpc_179_18  PMID:30598983
  298 49 -
Stature–weight growth delays: Clinical and etiological aspects
Houda Salhi, Asmae Lahlou, Mamadou L Dante, Hanan El Ouahabi, Saïd Boujraf, Farida Ajdi
September-October 2018, 7(5):963-966
DOI:10.4103/jfmpc.jfmpc_207_16  PMID:30598941
Background: Stature–weight growth delay (SWGD) is a frequent motivation of consultation. It could be a consequence of a known chronic affection, congenital or acquired affection. The purpose of this study is to describe epidemiological, clinical, paraclinical, and etiological aspects of SWGD. Patients and Methods: This retrospective study included 103 patients presenting a growth delay with an average age of 14.44 years and ranging between 5 and 21 years. Male predominance was noticed in 68.93% of cases. Patients showed a stature lower to −2 standard deviation (SD) for corresponding age compared to Sempe and Pedron reference. Patients were hospitalized in Endocrinology and Metabolic Diseases Department of the University Hospital of Fez, Fez, Morocco. Results: Patient's history included a perinatal suffering in 6.7% of cases, a chronic pathology follow-up in 17.6% of cases, and psychomotor development disorder in 10.6% of cases. The average weight was −2.37 SD with extremes varying from −4 to −0.5 SD. The stature values varied between −4.5 and −2 SD for the given age, with an average of −3.12 SD. A severe stature delay (< −3 SD) was recorded in 39.6% of cases and the targeted average size was −2.44 SD with extremes varying from −4 to −1.5 SD. Growth delay etiologies were dominated by a deficit in growth hormones (GHs) in 60% of cases. Discussion and Conclusion: Dynamic tests objectified a total deficit and partial deficits in GH in 41.7 and 30% of patients, respectively. The hypothalamo–pituitary magnetic resonance imaging was pathological in 23.3% of patients and showed a syndrome of interruption of pituitary stem in seven patients, pituitary hail gland in three patients, a craniopharyngioma in two patients, prolactin microadenoma in one patient, and nonfunctional pituitary microadenoma in one patient. GH treatment was established in 16 children that were presenting a deficit in GH, and two girls presenting Turner syndrome, whereas etiological treatment was suggested in all remaining cases.
  305 33 -
Pseudomelanosis intestini “from pylorus to jejunum:” A rare endoscopic finding in a patient with GI bleeding
Ali Zakaria, Backer Abdu, Bayan Al Share, Mia Manabat, Kha Ngo
September-October 2018, 7(5):1120-1122
DOI:10.4103/jfmpc.jfmpc_53_18  PMID:30598973
Pseudomelanosis of the gastrointestinal (GI) tract is a rare condition used to describe the accumulation of pigment deposits in the intestinal mucosa. Its underlying cause is not well understood. It has been described in association with gastrointestinal hemorrhage, chronic kidney disease, hypertension, diabetes mellitus, and medications such as hydralazine, ferrous sulfate, and furosemide. Melanosis coli is a well-known condition associated with the use of anthranoid laxatives; however, pseudomelanosis of the small intestine is extremely rare and most commonly described in the duodenum, with few cases in the gastric mucosa and even more rare in the jejunum. Herein, we report a case of pseudomelanosis intestini involving the pylorus, duodenum, and proximal jejunum in a patient presented with GI bleeding. The clinical significance of this condition is unknown; however, gastroenterologists should be aware of its existence.
  304 24 -
Association of hypertension and Vitamin D levels
Jogender Kumar, Arushi Yadav
September-October 2018, 7(5):1144-1145
DOI:10.4103/jfmpc.jfmpc_187_18  PMID:30598982
  277 40 -
The reliability and validity of using the urine dipstick test by patient self-assessment for urinary tract infection screening in spinal cord injury patients: Methodological and statistical issues on reliability and validity
Sajjad Rahimi Pordanjani, Sohrab Iranpour, Siamak Sabour
September-October 2018, 7(5):1148-1149
DOI:10.4103/jfmpc.jfmpc_224_18  PMID:30598984
  252 25 -
The missing pieces of the big picture: Unaddressed healthcare conundrums during demonetization
V Dinesh Kumar
September-October 2018, 7(5):1150-1151
DOI:10.4103/jfmpc.jfmpc_239_18  PMID:30598985
  245 23 -
“Project Dhoop” and primary healthcare personnel as its ambassador
Ganesh Singh Dharmshaktu
September-October 2018, 7(5):1143-1143
DOI:10.4103/jfmpc.jfmpc_196_18  PMID:30598981
  229 19 -